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Alyahya AA, Alghammass MA, Aldhahri FS, Alsebti AA, Alfulaij AY, Alrashed SH, Faleh HA, Alshameri M, Alhabib K, Arafah M, Moberik A, Almulaik A, Al-Aseri Z, Kashour TS. The impact of introduction of Code-STEMI program on the reduction of door-to-balloon time in acute ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention: A single-center study in Saudi Arabia. J Saudi Heart Assoc 2018; 30:172-179. [PMID: 29989037 PMCID: PMC6035382 DOI: 10.1016/j.jsha.2017.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 11/10/2022] Open
Abstract
Objectives This study was conducted to evaluate the effect of direct emergency department activation of the catheterization lab on door-to-balloon time (D2BT) and outcomes of acute ST-elevation myocardial infarction (STEMI) patients at a major tertiary care hospital in Riyadh, Saudi Arabia. Methods This was a retrospective cohort study that enrolled 100 consecutive patients with acute STEMI who underwent primary percutaneous coronary intervention between June 2010 and January 2015. The patients were divided into two groups of 50 patients each. The first group was treated prior to establishing the Code-STEMI protocol. The other group was treated according to the protocol, which was implemented in June 2013. The Code-STEMI protocol is a comprehensive program implementing direct activation of the catheterization lab team using a single call system, data monitoring and feedback, and standardized order forms. Results The mean age for both groups was 54 ± 12 years. Males represented 86% (43) and 94% (47) of the patients in the two groups, respectively. In both groups, 90% (90) of patients had one or more comorbidities. The Code-STEMI group had a significantly lower D2BT, with 70% of patients treated within the recommended 90 minutes (median, 76.5 minutes; interquartile range, 63–90 minutes). By contrast, only 26% of pre-Code-STEMI patients were treated within this timeframe (median, 107 minutes; interquartile range, 74–149 minutes). In-hospital complications were lower in the Code-STEMI group; however, the only statistically significant reduction was in non-fatal re-infarction (8% vs. 0%, p = 0.043). Conclusion Implementation of direct emergency department catheterization lab activation protocol was associated with a significant reduction in D2BT.
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Affiliation(s)
| | | | - Fahad Saleh Aldhahri
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | | | - Abdullah Yousef Alfulaij
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Saleh Hamad Alrashed
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Husam Al Faleh
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.,Department of Cardiology, King Fahad Cardiac Center, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Mostafa Alshameri
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.,Department of Cardiology, King Fahad Cardiac Center, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Alhabib
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.,Department of Cardiology, King Fahad Cardiac Center, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Arafah
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.,Department of Cardiology, King Fahad Cardiac Center, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Abduellah Moberik
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.,Department of Cardiology, King Fahad Cardiac Center, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz Almulaik
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.,Department of Emergency Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Zuhair Al-Aseri
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.,Department of Emergency Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Tarek Seifaw Kashour
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.,Department of Cardiology, King Fahad Cardiac Center, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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2
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Salam AM, Sulaiman K, Alsheikh-Ali AA, Singh R, Asaad N, Al-Qahtani A, Salim I, AlHabib KF, Al-Zakwani I, Al-Jarallah M, AlMahmeed W, Bulbanat B, Ridha M, Bazargani N, Amin H, Al-Motarreb A, Al Faleh H, Albackr H, Panduranga P, Shehab A, Al Suwaidi J. Acute heart failure presentations and outcomes during the fasting month of Ramadan: an observational report from seven Middle Eastern countries. Curr Med Res Opin 2018; 34:237-245. [PMID: 28871820 DOI: 10.1080/03007995.2017.1376629] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Fasting during the month of Ramadan is practiced by over 1.5 billion Muslims worldwide. It remains unclear, however, how this change in lifestyle affects heart failure, a condition that has reached epidemic dimensions. This study examined the effects of fasting in patients with acute heart failure (AHF) using data from a large multi-center heart failure registry. METHODS AND RESULTS Data were derived from Gulf CARE (Gulf aCute heArt failuRe rEgistry), a prospective multi-center study of consecutive patients hospitalized with AHF during February-November 2012. The study included 4,157 patients, of which 306 (7.4%) were hospitalized with AHF in the fasting month of Ramadan, while 3,851 patients (92.6%) were hospitalized in other days. Clinical characteristics, precipitating factors, management, and outcome were compared among the two groups. Patients admitted during Ramadan had significantly lower prevalence of symptoms and signs of volume overload compared to patients hospitalized in other months. Atrial arrhythmias were significantly less frequent and cholesterol levels were significantly lower in Ramadan. Hospitalization in Ramadan was not independently associated with increased immediate or 1-year mortality. CONCLUSIONS The current study represents the largest evaluation of the effects of fasting on AHF. It reports an improved volume status in fasting patients. There were also favorable effects on atrial arrhythmia and total cholesterol and no effects on immediate or long-term outcomes.
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Affiliation(s)
- Amar M Salam
- a Adult Cardiology , Hamad Medical Corporation , Doha , Qatar
| | | | - Alawi A Alsheikh-Ali
- c College of Medicine , Mohammed Bin Rashid University of Medicine and Health Sciences , Dubai , United Arab Emirates
- d Institute of Cardiac Sciences , Sheikh Khalifa Medical City , Abu Dhabi , United Arab Emirates
| | - Rajvir Singh
- e Biostatistics Section, Cardiovascular Research , Heart Hospital, Hamad Medical Corporation , Doha , Qatar
| | - Nidal Asaad
- a Adult Cardiology , Hamad Medical Corporation , Doha , Qatar
| | - Awad Al-Qahtani
- a Adult Cardiology , Hamad Medical Corporation , Doha , Qatar
| | - Imtiaz Salim
- a Adult Cardiology , Hamad Medical Corporation , Doha , Qatar
| | - Khalid F AlHabib
- f Department of Cardiac Sciences , King Fahad Cardiac Center, King Saud University , Riyadh , Saudi Arabia
| | - Ibrahim Al-Zakwani
- g College of Medicine & Health Sciences, Department of Pharmacology & Clinical Pharmacy , Sultan Qaboos University, and Gulf Health Research , Oman
| | | | | | - Bassam Bulbanat
- h Department of Cardiology , Sabah Al-Ahmed Cardiac Center , Kuwait
| | | | - Nooshin Bazargani
- k Department of Cardiology , Dubai hospital , Dubai , United Arab Emirates
| | - Haitham Amin
- l Department of Cardiology , Mohammed Bin Khalifa Cardiac Center , Manamah , Bahrain
| | - Ahmed Al-Motarreb
- m Department of Cardiology, Faculty of Medicine , Sana'a University , Sana'a , Yemen
| | - Husam Al Faleh
- n Department of Cardiology and Cardiovascular Surgery , Security Forces Hospital , Riyadh , Saudi Arabia
| | - Hanan Albackr
- f Department of Cardiac Sciences , King Fahad Cardiac Center, King Saud University , Riyadh , Saudi Arabia
| | | | - Abdulla Shehab
- o Internal Medicine Department , College of Medicine and Health Sciences (CMHS), UAE University , United Arab Emirates
| | - Jassim Al Suwaidi
- a Adult Cardiology , Hamad Medical Corporation , Doha , Qatar
- p Qatar Cardiovascular Research Center , Doha , Qatar
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Abi Khalil C, Sulaiman K, Mahfoud Z, Singh R, Asaad N, AlHabib KF, Alsheikh-Ali A, Al-Jarallah M, Bulbanat B, AlMahmeed W, Ridha M, Bazargani N, Amin H, Al-Motarreb A, Faleh HA, Elasfar A, Panduranga P, Suwaidi JA. Non-withdrawal of beta blockers in acute decompensated chronic and de novo heart failure with reduced ejection fraction in a prospective multicentre study of patients with acute heart failure in the Middle East. BMJ Open 2017; 7:e014915. [PMID: 28694343 PMCID: PMC5734353 DOI: 10.1136/bmjopen-2016-014915] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Beta blockers reduce mortality in heart failure (HF). However, it is not clear whether they should be temporarily withdrawn during acute HF. DESIGN Analysis of prospectively collected data. SETTING The Gulf aCute heArt failuRe rEgistry is a prospective multicentre study of patients hospitalised with acute HF in seven Middle Eastern countries. PARTICIPANTS 5005 patients with acute HF. OUTCOME MEASURES We studied the effect of beta blockers non-withdrawal on intrahospital, 3-month and 12-month mortality and rehospitalisation for HF in patients with acute decompensated chronic heart failure (ADCHF) and acute de novo heart failure (ADNHF) and a left ventricular ejection fraction (LVEF) <40%. RESULTS 44.1% of patients were already on beta blockers on inclusion. Among those, 57.8% had an LVEF <40%. Further, 79.9% were diagnosed with ADCHF and 20.4% with ADNHF. Mean age was 61 (SD 13.9) in the ADCHF group and 59.8 (SD 13.8) in the ADNHF group. Intrahospital mortality was lower in patients whose beta blocker therapy was not withdrawn in both the ADCHF and ADNHF groups. This protective effect persisted after multivariate analysis (OR 0.05, 95% CI 0.022 to 0.112; OR 0.018, 95% CI 0.003 to 0.122, respectively, p<0.001 for both) and propensity score matching even after correcting for variables that remained significant in the new model (OR 0.084, 95% CI 0.015 to 0.468, p=0.005; OR 0.047, 95% CI 0.013 to 0.169, p<0.001, respectively). At 3 months, mortality was still lower only in patients with ADCHF in whom beta blockers were maintained during initial hospitalisation. However, the benefit was lost after correcting for confounding factors. Interestingly, rehospitalisation for HF and length of hospital stay were unaffected by beta blockers discontinuation in all patients. CONCLUSION In summary, non-withdrawal of beta blockers in acute decompensated chronic and de novo heart failure with reduced ejection fraction is associated with lower intrahospital mortality but does not influence 3-month and 12-month mortality, rehospitalisation for heart failure,and the length of hospital stay. TRIAL REGISTRATION NUMBER NCT01467973; Post-results.
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Affiliation(s)
- Charbel Abi Khalil
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar
- Department of Genetic Medicine, Weill Cornell Medicine, Doha, Qatar
- Adult Cardiology Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Ziyad Mahfoud
- Division of Global and Public Health, Weill Cornell Medicine, Doha, Qatar
| | - Rajvir Singh
- Adult Cardiology Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Nidal Asaad
- Adult Cardiology Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Alawi Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
| | | | | | - Wael AlMahmeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, UAE
| | - Mustafa Ridha
- Department of Cardiology, Adan Hospital, Kuwait, Kuwait
| | | | - Haitham Amin
- Department of Cardiology, Mohammed Bin Khalifa Cardiac Center, Manamah, Bahrain
| | - Ahmed Al-Motarreb
- Department of cardiology, Faculty of Medicine, Sana’a University, Sana, Yemen
| | - Husam Al Faleh
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Jassim Al Suwaidi
- Adult Cardiology Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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Salam AM, Sulaiman K, Al-Zakwani I, Alsheikh-Ali A, Aljaraallah M, Al Faleh H, Elasfar A, Panduranga P, Singh R, Abi Khalil C, Al Suwaidi J. Coronary artery disease prevalence and outcome in patients hospitalized with acute heart failure: an observational report from seven Middle Eastern countries. Hosp Pract (1995) 2016; 44:242-251. [PMID: 27737597 DOI: 10.1080/21548331.2016.1246945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The purpose of this study was to report prevalence, clinical characteristics, precipitating factors, management and outcome of patients with coronary artery disease (CAD) among patients hospitalized with heart failure (HF) in seven Middle Eastern countries and compare them to non-CAD patients. METHODS Data were derived from Gulf CARE (Gulf aCute heArt failuRe rEgistry), a prospective multicenter study of 5005 consecutive patients hospitalized with acute HF during February-November 2012 in 7 Middle Eastern countries. RESULTS The prevalence of CAD among Acute Heart Failure (AHF) patients was 60.2% and varied significantly among the 7 countries (Qatar 65.7%, UAE 66.6%, Kuwait 68.0%, Oman 65.9%, Saudi Arabia 62.5%, Bahrain 52.7% and Yemen 49.1%) with lower values in the lower income countries. CAD patients were older and more likely to have diabetes, hypertension, dyslipidemia and chronic kidney disease. Moreover, CAD patients were more likely to have history of cerebrovascular and peripheral vascular disease when compared to non-CAD patients. In-hospital mortality rates were comparable although CAD patients had more frequent re-hospitalization and worse long-term outcome. However, CAD was not an independent predictor of poor outcome. CONCLUSION The prevalence of CAD amongst patients with HF in the Middle East is variable and may be related to healthcare sources. Regional and national studies are needed for assessing further the impact of various etiologies of HF and for developing appropriate strategies to combat this global concern.
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Affiliation(s)
- Amar M Salam
- a Department of Cardiology , Al-khor Hospital, Hamad Medical Corporation , Doha , Qatar
| | | | - Ibrahim Al-Zakwani
- c Department of Pharmacology & Clinical Pharmacy , Sultan Qaboos University , Muscat , Oman
| | - Alawi Alsheikh-Ali
- d College of Medicine , Mohammed Bin Rashid Medical University , Dubai , United Arab Emirates
| | | | - Husam Al Faleh
- f Department of Cardiology and Cardiovascular Surgery , King Saud University , Riyadh , Saudi Arabia
| | - Abdelfatah Elasfar
- g Department of Cardiology , Prince Salman Hospital , Riyadh , Saudi Arabia
| | | | - Rajvir Singh
- a Department of Cardiology , Al-khor Hospital, Hamad Medical Corporation , Doha , Qatar
| | - Charbel Abi Khalil
- h Department of Genetic Medicine and Department of Medicine , Weill Cornell Medical College in Qatar , Doha , Qatar
| | - Jassim Al Suwaidi
- i Department of Adult Cardiology and Cardiovascular Surgery , Heart Hospital, Hamad Medical Corporation , Doha , Qatar
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Khafaji HAR, Sulaiman K, Singh R, Alhabib KF, Asaad N, Alsheikh-Ali A, Al-Jarallah M, Bulbanat B, Almahmeed W, Ridha M, Bazargani N, Amin H, Al-Motarreb A, Faleh HA, Elasfar A, Panduranga P, Suwaidi JA. Chronic obstructive airway disease among patients hospitalized with acute heart failure; clinical characteristics, precipitating factors, management and outcome: Observational report from the Middle East. ACTA ACUST UNITED AC 2016; 17:55-66. [DOI: 10.1080/17482941.2016.1203438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Hadi A. R. Khafaji
- Department of Cardiology, Saint Michael's Hospital, Toronto University, Toronto, Canada
| | - Kadhim Sulaiman
- Biostatistics Section, Department of Cardiology, Royal Hospital, Muscat, Oman
| | - Rajvir Singh
- Cardiovascular Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Khalid F. Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Nidal Asaad
- Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Alawi Alsheikh-Ali
- Department of Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | | | - Bassam Bulbanat
- Department of Cardiology, Sabah Al-Ahmed Cardiac Center, Kuwait City, Kuwait
| | - Wael Almahmeed
- Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mustafa Ridha
- Department of Cardiology, Adan Hospital, Hadiya, Kuwait
| | - Nooshin Bazargani
- Department of Cardiology, Dubai Hospital, Dubai, United Arab Emirates
| | - Haitham Amin
- Department of Cardiology, Mohammed Bin Khalifa Cardiac Center, Manamah, Bahrain
| | - Ahmed Al-Motarreb
- Department of Cardiology, Faculty of Medicine, Sana'a University, Sana'a, Yemen
| | - Husam Al Faleh
- Department of Cardiology and Cardiovascular Surgery, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Abdelfatah Elasfar
- Department of Cardiology, Prince Salman Heart Center, King Fahad Medical City, Saudi Arabia
| | | | - Jassim Al Suwaidi
- Cardiovascular Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
- Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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Al-Lawati JA, Al-Zakwani I, Sulaiman K, Al-Habib K, Al Suwaidi J, Panduranga P, Alsheikh-Ali AA, Almahmeed W, Al Faleh H, Al Saif S, Hersi A, Asaad N, Al-Motarreb A, Mikhailidis DP, Amin H. Weekend versus weekday, morning versus evening admission in relationship to mortality in acute coronary syndrome patients in 6 middle eastern countries: results from gulf race 2 registry. Open Cardiovasc Med J 2012; 6:106-12. [PMID: 23002404 PMCID: PMC3447162 DOI: 10.2174/1874192401206010106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 07/15/2012] [Indexed: 12/04/2022] Open
Abstract
We used prospective cohort data of patients with acute coronary syndrome (ACS) to compare their management on weekdays/mornings with weekends/nights, and the possible impact of this on 1-month and 1-year mortality. Analyses were evaluated using univariate and multivariate statistics. Of the 4,616 patients admitted to hospitals with ACS, 76% were on weekdays. There were no significant differences in 1-month (odds ratio (OR), 0.88; 95% CI: 0.68-1.14) and 1-year mortality (OR, 0.88; 95% CI: 0.70-1.10), respectively, between weekday and weekend admissions. Similarly, there were no significant differences in 1-month (OR, 0.92; 95% CI: 0.73-1.15) and 1-year mortality (OR, 0.98; 95% CI: 0.80-1.20), respectively, between nights and day admissions. In conclusion, apart from lower utilization of angiography (P < .001) at weekends, there were largely no significant discrepancies in the management and care of patients admitted with ACS on weekdays and during morning hours compared with patients admitted on weekends and night hours, and the overall 30-day and 1-year mortality was similar between both the cohorts.
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Affiliation(s)
- Jawad A Al-Lawati
- Department of Non-Communicable Diseases Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Ibrahim Al-Zakwani
- Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
- Gulf Health Research, Muscat, Oman
| | | | - Khalid Al-Habib
- King Fahad Cardiac Centre, King Khalid University Hospital, College of Medicine, Riyadh, Saudi Arabia
| | - Jassim Al Suwaidi
- Department of Cardiology, Hamad Medical Corporation (HMC), Doha, Qatar
| | | | - Alawi A Alsheikh-Ali
- Department of Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
- Tufts Clinical and Translational Science Institute and Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Wael Almahmeed
- Department of Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Husam Al Faleh
- King Fahad Cardiac Centre, King Khalid University Hospital, College of Medicine, Riyadh, Saudi Arabia
| | | | - Ahmad Hersi
- King Fahad Cardiac Centre, King Khalid University Hospital, College of Medicine, Riyadh, Saudi Arabia
| | - Nidal Asaad
- Department of Cardiology, Hamad Medical Corporation (HMC), Doha, Qatar
- Weill Cornell Medical School, Doha, Qatar
| | | | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital, University College London Medical School, University College London, London, England, UK
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